Dataset Information

Inpatient omission of ACEi and ARBs is associated with morbidity and mortality in COVID-19

ABSTRACT:

Purpose

Due to the affinity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for the human angiotensin converting enzyme 2 (ACE2) receptor, use of angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) has been a major concern for clinicians during the 2020 pandemic. Meta-analyses have affirmed that these agents do not worsen clinical outcomes in SARS-CoV-2 infection. To date, only a limited number of studies have directly looked at the safety of inpatient prescription of ACEi/ARBs during acute COVID-19 illness.

Methods

A retrospective cohort analysis was conducted to investigate the impact of inpatient provision of ACEi/ARBs on morbidity and mortality in patients admitted to hospital with COVID-19. Relationships were explored using linear and logistic regression.

Findings

Six hundred and twelve adult patients met our inclusion criteria of which 151 (24.7%) patients were established on ACEi/ARBs. Despite correction for known confounders, discontinuation of ACEi/ARBs was highly predictive of worsened outcomes in COVID-19. The proportion of doses omitted in hospital was significantly associated with increased mortality (p<0.001, OR=9.59 [2.55-36.09]), maximum National Early Warning Score (NEWS-2; p<0.001, OR=1.66 [1.27-2.17]), maximum oxygen requirements (p<0.001, OR=3.00 [1.83-4.91]), and maximum C-Reactive Protein concentration (CRP; p=0.030, OR=1.83 [1.06-3.17]).

Implications

Our data demonstrates a strong association between missed ACEi/ARB doses with increased morbidity and mortality. The available evidence supports continuation of current accepted practice surrounding ACEi/ARB therapy in acute illness – which is to limit drug omission to established acute contraindications, to actively monitor such decisions and to restart therapy as soon as it is safe to do so.

SUBMITTER: Oddy C

PROVIDER: S-EPMC7906507 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:Aims and objectives: The pandemic of COVID-19 is evolving worldwide, and it is associated with high mortality and morbidity. There is a growing need to discuss the elements of a coordinated strategy to control the spread and mitigate the severity of COVID-19. H1N1 and Streptococcus pneumonia vaccines are available. The current analysis was performed to analyze the severity of COVID-19 and influenza (H1N1) vaccination in adults ≥ 65. Also, to correlate the lower respiratory tract infections (LRIs), and influenza attributable to the lower respiratory tract infections' incidence with Covid-19 mortality. Evolutionarily influenza is close in resemblance to SARS-CoV-2 viruses and shares some common epitopes and mechanisms. Methods: Recent influenza vaccination data of 34 countries from OECD and other publications were correlated with COVID-19 mortality from worldometer data. LRIs attributable to influenza and streptococcus pneumonia were correlated with COVID-19 mortality. Specifically, influenza-attributable LRI incidence data of various countries (n = 182) was correlated with COVID-19 death by linear regression and receiver operating characteristic (ROC) curve analyzes. In a logistic regression model, population density and influenza LRI incidence were correlated with COVID-19 mortality. Results: There is a correlation between COVID-19-related mortality, morbidity, and case incidence and the status of influenza vaccination, which appears protective. The tendency of correlation is increasingly highlighted as the pandemic is evolving. In countries where influenza immunization is less common, there is a correlation between LRIs and influenza attributable to LRI incidence and COVID-19 severity, which is beneficial. ROC curve showed an area under the curve of 0.86 (CI 0.78 to 0.944, P < 0.0001) to predict COVID-19 mortality >150/million and a decreasing trend of influenza LRI episodes. To predict COVID-19 mortality of >200/million population, the odds ratio for influenza incidence/100,000 was -1.86 (CI -2.75 to -0.96, P < 0.0001). To predict the parameter Covid-19 mortality/influenza LRI episodes*1000>1000, the influenza parameter had an odd's ratio of -3.83 (CI -5.98 to -1.67), and an AUC of 0.94. Conclusion: Influenza (H1N1) vaccination can be used as an interim measure to mitigate the severity of COVID-19 in the general population. In appropriate high-risk circumstances, Streptococcus pneumonia vaccination would also be an adjunct strategy, especially in countries with a lower incidence of LRIs.

Project description:BACKGROUND:Measles is an extremely contagious, vaccine-preventable infection that was officially declared eradicated in the US in 2000. However, measles outbreaks are increasingly occurring in the US. Measles cases have considerable morbidity requiring hospitalization, yet little is known about hospitalization and complications from measles in recent years. OBJECTIVES:To analyze the frequency, predictors, costs and other outcomes of hospitalization for measles in the US. METHODS:The 2002-2016 Nationwide Inpatient Sample, containing a 20% sample of US hospitalizations (n = 96,568,625), was analyzed. Measles and comorbidities were defined by International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) or ICD-10-CM codes. Multivariable survey logistic regression and linear regression models controlling for sociodemographic demographic factors were constructed to understand associations with organ-specific complications, and cost of care and length of stay, respectively. RESULTS:Overall, 1,018 measles hospitalizations occurred in 2002-2016, and hospitalizations increased over time. In multivariable logistic regression models, measles was associated with higher odds of gastrointestinal, hematologic, infectious, neurologic, ophthalmologic, pulmonary, and renal complications, with the strongest association observed with encephalitis (39.84 [16.51-96.12], P<0.0001). Increased length of stay (LOS) and similar cost of care (mean [95% CI]; 4.8 [4.4-5.4]; $7,438 [$6,446-$8,582]) were observed versus (vs.) all other admissions (4.5 [4.4-4.5]; P<0.01; $7,854 [$7,774-$7,935], P>0.05). There were 34 deaths in hospitalized measles patients; inpatient mortality was numerically higher in those with vs. without measles (proportion ± SEM: 3.3±1.2% vs. 2.3±0.01%, P = 0.333). LIMITATIONS:Lack of outpatient or prescription data. CONCLUSIONS:Measles continues to pose a substantial and preventable health care burden, with serious complications, hospitalization and inpatient mortality. Further studies are needed to improve the prevention and management of measles.